Word: Pediatric Intensive Care Unit: Continuous Infusion...
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Word: Pediatric Intensive Care Unit: Continuous Infusion Guidelines for Infants and Children
PEDIATRIC INTENSIVE CARE UNIT: CONTINUOUS INFUSION GUIDELINES FOR INFANTS AND CHILDREN
DOCUMENT TYPE: GUIDELINES
Site Applicability
This chart has been developed for use in The Pediatric Intensive Care Area of BC Children’s Hospital. The information contained here is intended as a guideline for use of standard concentrations of “high alert” medications administered by continuous infusion. For more detailed information on these drugs, the user should consult other comprehensive reference sources.
Definitions:
Patient Group: These guidelines normally apply to full term neonates, infants and children. This information is not intended to apply to premature newborns. Please refer to the Neonatal Drug Manual from Newborn Services for information about this specific age group
Drug: Listed by generic name. Trademark and alternate names are included in parenthesis. Other pharmaceutical information such as solution pH, osmolality (in mOsm/mL), specific gravity (SG) and additive content has been included to assist in decision making about the administration of these drugs.
Concentration: Represented as a weight/volume relationship, namely milligrams per milliliter or micrograms per milliliter. The concentrations suggested reflect those that are approved at this facility for administration to critically ill children. These standard concentrations will be supplied by Pharmacy. In some situations, nurses may mix the drugs at the bedside. Generally the listed concentrations are appropriate for all age groups; however, when applicable, specific recommendations are presented for different age groups. The concentration selected will be determined by the tolerance for fluid volume delivered with medications. Fluid restricted patients may require more concentrated solutions. In cases where the patient is not fluid restricted more dilute solutions should be chosen. Solution properties such as osmolality and pH may be considered when selecting concentrations suitable for peripheral line or central line administration. As a general rule, osmolality values greater than 600 mOsm/mL indicate that the medication be given by central venous catheter. Minimum and maximum recommended concentrations for infusion are included where applicable.
Infusion Rate and Dose Delivered: This relationship will be determined with the use of infusion drug charts or “smart pumps” which have been programmed to infuse at the proper rate when dose and weight are entered into the database.
Dose Range: The usual dose range for continuous infusions recommended by the literature under standard conditions. Loading doses, bolus doses, and maximum recommended doses are included where applicable.
Y-Site Compatibility: Medications should not be admixed in one container. To avoid directly admixing of two drugs medications are administered via Y-site connectors. This compatibility information contained in the chart applies to Y-site administration only. Legend: C; compatible at Y-site, I: incompatible at Y-site. Where co-infusion of TPN by Y-site is acceptable, it is noted in the comments section.
Comments:Other useful information pertaining to the use of each drug is presented, such as:
· central or peripheral line recommendations. (Most standard concentrations can be administered via peripheral line)
· adverse effects, including infusion reactions
· protect infusion container (syringe or bag) and/or tubing from light, only where noted
· solution expiry noted, change tubing at specified time
It is the responsibility of the nurse to verify that the dilution used will deliver the correct dose at a calculated infusion rate.
Two nurses must verify the infusion rate is correct.
Drug
Concentrations
Infusion Rate
Dose Range
Y-Site Compatibility
Comments
Alprostadil
[Prostaglandin E1, Prostin VP]
500 mcg/mL
pH = 4.8 – 5
Osmolality = 23,250
Revised February 2020
Standard Concentrations
Patients < 6 kg:
5 mcg/mL
Add 0.25 mL of
500 mcg/mL to
24.75 mL D5W to make 25 mL of
5 mcg/mL
Patients > 6 kg, Peripheral line:
10 mcg/mL
Add 0.5 mL of
500 mcg/mL to
24.5 mL D5W to make 25 mL of
10 mcg/mL
Patients > 6 kg,
Central line:
20 mcg/mL
Add 1 mL of
500 mcg/mL to
24 mL D5W to make 25 mL of
20 mcg/mL
Use Alaris Pump to determine infusion rate.
AND
Confirm with the following calculation:
Infusion rate (mL/h) = Dose (mcg/kg/min)
x Weight (kg)
x 60 (min/h)
divided by
Concentration (mcg/mL)
To maintain patency of ductus arteriosus
0.005 – 0.1 mcg/kg/min
C: dextrose and saline solutions, aminophylline, atropine, caffeine, calcium chloride, calcium gluconate, dexamethasone, dobutamine, dopamine, epinephrine, furosemide, heparin, hydrocortisone, isoproterenol, lidocaine, midazolam, morphine, nitroglycerin, nitroprusside, pancuronium, potassium chloride,
I: sodium bicarbonate
Compatible with TPN
· Central line administration only for concentrations >10 mcg/mL.
· If being administered via peripheral line or low-lying UVC, patient should have two lines in place during the infusion (one for alprostadil and an additional line)
• Adverse effects include apnea and bradycardia
• For fever or hypotension, reduce infusion rate
• For cutaneous flushing, reposition catheter
• Extravasation of concentrated solution may cause tissue sloughing and necrosis.
· Keep ampoules in refrigerator.
· Change solution at 24 hours.
· Ref: 1, 2, 3, 4
Drug
Concentrations
Infusion Rate
Dose Range
Y-Site Compatibility
Comments
Alteplase (rTPA)
[Activase]
50 mg vial containing lyophilized powder (plus 50 mL of diluent, SWI)
pH = 7.3,
Osmolality = 215
Revised Feb 2020
Standard Concentration
1 mg/mL
Add 50 mL enclosed diluent to 50 mg vial to make 1 mg/mL solution.
Use Alaris Pump to determine infusion rate.
AND
Confirm with the following calculation:
Infusion rate (mL/h) = Dose (mg/kg/h)
x Weight (kg)
divided by
Concentration (mg/mL)
Systemic Thrombolysis
0.1 – 0.6 mg/kg/h
Start at 0.1 mg/kg/h; may increase dose by 0.1 mg/kg/h every 6 hours
Dose is titrated to target fibrinogen levels: >1 g/L
(>1.5 g/L in neonates)
C: D5W, NS, morphine, lidocaine, propranolol
I: dobutamine, dopamine, heparin, nitroglycerin, bacteriostatic water, bacteriostatic saline
· Reconstitute with enclosed diluent (SWI) only. Roll gently, do not shake. Let stand for several minutes prior to administration.
· Monitor for signs of bleeding.
· Extravasation can cause ecchymosis and inflammation
· Dilutions <0.5 mg/mL may result in precipitation.
· Do not directly admix with other medications or solutions.
· Change solution every 8 hours.
· Ref: 2
Drug
Concentrations
Infusion Rate
Dose Range
Y-Site Compatibility
Comments
Aminophylline
Revised Feb 2020
Standard Concentrations
1 mg/mL:
Add 2 mL of
25 mg/mL to
48 mL of D5W to make 50 mL of 1 mg/mL
5 mg/mL:
Add 10 mL of
25 mg/mL to
40 mL of D5W to make 50 mL of 5 mg/mL
10 mg/mL:
Add 20 mL of
25 mg/mL to
30 mL of D5W to make 50 mL of 10 mg/mL
Use Alaris Pump to determine infusion rate.
AND
Confirm with the following calculation:
Infusion rate (mL/h) = Dose (mg/kg/h) x Weight (kg)
divided by Concentration (mg/mL)
Bronchodilator
Loading Dose:
6 mg/kg IV over 20 minutes
Continuous infusion:
6 wk-6 mos: 0.5 mg/kg/h IV
6-12 mos: 0.7 mg/kg/h IV
1-9 years: 1-1.2 mg/kg/h IV
9-16 yrs: 0.7-0.8 mg/kg/h IV
C: D5W, D10W, D5NS, NS, D51/2NS, D5LR, calcium chloride, calcium gluconate, dopamine, esmolol, fentanyl, furosemide, heparin, regular insulin, labetalol, lidocaine, lorazepam, milrinone, morphine, nitroglycerin, phenobarbital, potassium chloride, procainamide, sodium bicarbonate
I: TPN, amiodarone, dobutamine, epinephrine, hydralazine, isoproterenol, magnesium sulfate (250mg/mL), midazolam, norepinephrine, ondansetron, phenytoin
· May cause hypotension and/or bradycardia with rapid infusions or loading doses.
· Change solution at 24 hours.
Therapeutic Drug Monitoring:
· Aminophylline contains 80% theophylline
· Therapeutic theophylline range is 55 to 111 micromoles/L
· Draw serum theophylline levels - 30 mins after loading dose, and at 24-hour intervals for the duration of an infusion
· For loading doses, each 1.25mg/kg of aminophylline raises the serum theophylline approximately 11 micromoles/L
· Refer to BCCH Pediatric Drug Dosage Guidelines for guidelines to adjust dosage based on serum concentration
· Ref: 2, 3, 4, 7
Drug
Concentrations
Infusion Rate
Dose Range
Y-Site Compatibility
Comments
Amiodarone
[Cordarone]
150 mg/3 mL
pH = 4.08
Contains polysorbate 80, benzyl alcohol
Revised Feb 2020
Standard Concentrations
Peripheral line:
2000 mcg/mL
(2 mg/mL)
Add 2 mL of
50 mg/mL to
48 mL D5W to make 50 mL of
2000 mcg/mL
(2000 mcg/mL = 2 mg/mL)
Central line:
6000 mcg/mL
(6 mg/mL)
Add 6 mL of
50 mg/mL to
44 mL of D5W to make 50 mL of 6000 mcg/mL (6000 mcg/mL = 6 mg/mL)
Use Alaris Pump to determine infusion rate.
AND
Confirm with the following calculation:
Infusion rate (mL/h) = Dose (mcg/kg/min) x Weight (kg)
x 60 (min/h)
divided by Concentration (mcg/mL)
Arrhythmia
2 mg/kg IV loading dose over 20 minutes, followed by
5 mcg/kg/min
If inadequate response:
1 mg/kg IV over 10 minutes, followed by 5-10 mcg/kg/min
Usual continuous infusion dosage:
5-15 mcg/kg/min
OR
25 mcg/kg/min IV for 4 hours, followed by
5 – 15 mcg/kg/min
PALS algorithms:
5 mg/kg IV loading dose over 20-60 minutes
C: D5W, NS, calcium chloride, calcium gluconate, dobutamine, dopamine, esmolol, fentanyl, insulin, isoproterenol, potassium chloride, labetalol, lidocaine, lorazepam, midazolam, milrinone, morphine, nitroglycerin, norepinephrine
I: aminophylline, heparin, furosemide, procainamide, sodium bicarbonate, magnesium sulfate (500 mg/mL)
· Central line administration preferred.
· Peripheral line administration may be used for concentrations <2000 mcg/mL (2 mg/mL).
· Use Medex non-DEHP tubing # MX448HL60 with 30 mL tubing to infuse the solution.
· Use of 0.22 micron inline filter is recommended.
· May cause hypotension and/or bradycardia with rapid infusions or loading doses.
· Change solution at 24 hours.
· Ref: 2, 3, 4, 7
Drug
Concentrations
Infusion Rate
Dose Range
Y-Site Compatibility
Comments
Calcium Chloride
[CaCl2]
10% (100 mg/mL)
Each mL contains:
100 mg CaCl2
27.2 mg Ca+2
0.68 mmol Ca+2
pH = 5.5 – 7.5
Osmolality = 1760
Revised Dec 2013
Reviewed Jan 2020
Standard Concentrations
Central line:
100 mg/mL
(undiluted)
(0.68 mmol Ca+2/mL)
Use Alaris Pump to determine infusion rate.
AND
Confirm with the following calculation:
Infusion rate (mL/h) = [Dose (mmol/kg/d)
x Weight (kg)]
divided by
[Concentration (mmol/mL)
x 24 (h/d)]
Hypocalcemia
0.5 – 1.5 mmol Ca+2/kg/day
(74 – 221 mg/kg/day of calcium chloride)
C: dextrose and saline solutions, dopamine, esmolol, fentanyl, furosemide, heparin, insulin, isoproterenol, midazolam, milrinone, morphine, nitroprusside, norepinephrine,
I: amphotericin, bicarbonate, ceftriaxone, dobutamine, lipids magnesium, phosphate, propofol
Incompatible with TPN solutions containing phosphates
· Extravasation may cause severe tissue burns and necrosis.
· Central line administration only.
· If peripheral line infusion use calcium gluconate
· Do not infuse via small veins (i.e., scalp).
· Monitor ionized calcium daily (target 1.1 – 1.3 mmol/L).
· Change solution at 96 hours.
· Ref: 3, 5
Drug
Concentrations
Infusion Rate
Dose Range
Y-Site Compatibility
Comments
Calcium Gluconate
10% (100 mg/mL)
Each mL contains:
100 mg calcium
gluconate
9.3 mg Ca+2
0.232 mmol Ca+2
pH = 6 – 8.2
Osmolality = 276
Revised Nov 2013
Reviewed Jan 2020
Standard Concentrations
Peripheral line:
20 mg/mL
(0.046 mmol Ca+2/mL)
Add 10 mL of 10% solution to 40 mL D5W to make
50 mL of
20 mg/mL
Central line:
100 mg/mL
(undiluted)
(0.232 mmol Ca+2/mL)
Use Alaris Pump to determine infusion rate.
AND
Confirm with the following calculation:
Infusion rate (mL/h) = [Dose (mg/kg/d)
x Weight (kg)]
divided by
[Concentration (mg/mL)
x 24 (h/d)]
Hypocalcemia, Hyperkalemia, or Calcium Channel Blocker Toxicity
Neonates
200 – 400 mg/kg/day
(0.46 – 0.93 mmol Ca+2/kg/day)
Infants & Children
200 – 500 mg/kg/day
(0.46 – 1.2 mmol Ca+2/kg/day)
Maximum Dose
240 mg/kg/h
C: aminophylline, dobutamine, dopamine, epinephrine, fentanyl, furosemide, heparin, insulin, isoproterenol, labetalol, lidocaine, magnesium, midazolam, milrinone, morphine, nitroprusside, norepinephrine, potassium chloride, propofol
I: amphotericin, bicarbonate, phosphates
Incompatible with TPN solutions containing phosphates
· Extravasation may cause severe tissue burns and necrosis.
· Central line administration is preferred.
· Peripheral line infusions must be approved by the Attending Physician and use standard concentration of 20 mg/mL
· Central line administration only for concentrations >20 mg/mL.
· Do not infuse via small veins (i.e., scalp).
· Change solution at 96 hours.
· Ref: 3, 6, 7
Drug
Concentrations
Infusion Rate
Dose Range
Y-Site Compatibility
Comments
Cisatracurium
20 mg/10mL
(2mg/mL)
Revised Feb 2020
Standard Concentration:
100 mcg/mL
Add 2.5 mL of 2 mg/mL to 47.5 mL D5W or NS to make 50 mL of 0.1 mg/mL = 100 mcg/mL)
400 mcg/mL
Add 10 mL of 2mg/mL to 40 mL D5W or NS to make 50 mL of 0.4 mg/mL = 400 mcg/mL)
Calculate the infusion rate with the following calculation:
Infusion rate (mL/h) = Dose (mcg/kg/min)
x Weight (kg)
x 60 (min/h)
divided by
Concentration (mcg/mL)
Continuous infusion:
1 – 4 mcg/kg/min
(0.06 – 0.24 mg/kg/hr)
Intermittent:
Initial 0.1 mg/kg followed by maintenance of 0.03 mg/kg PRN to maintain blockade
C: D5W, NS, D5NS, D5LR, bumetanide, dopamine, epinephrine, fentanyl, gentamicin, midazolam, morphine, norepinephrine, vancomycin
Variable compatibility (depends on concentrations):
cefazolin, cefotaxime
· Change solution at: 96 hours
· Ref: 1, 3
Drug
Concentrations
Infusion Rate
Dose Range
Y-Site Compatibility
Comments
Dexmedetomidine
(Precedex)
100 mcg/mL (2mL vial)
pH = 4.5 – 7
Revised Dec 2013
Reviewed Feb 2020
Standard Concentrations
4 mcg/mL:
Add 2mL of 100 mcg/mL solution to 48 mL NS to make 50 mL of 4 mcg/mL
Use Alaris Pump to determine infusion rate.
AND
Confirm with the following calculation:
Infusion rate (mL/h) = [Dose (mcg/kg/hour)
x Weight (kg)]
divided by
4 (mcg/mL)
Sedation for Mechanical Ventilation
Loading dose: 0.2 – 0.6 mcg/kg over 10 – 20 minutes
Infusion: Initially 0.2 micrograms/kg/hour
Titrate to range of 0.2-0.7 mcg/kg/hour
Usual max 1 mcg/kg/hour (may go up to 1.4 mcg/kg/hour)
Burn Patients.
Loading dose: 0.2 – 0.6 mcg/kg over 10 – 20 minutes
Infusion: Initially 0.2 mcg/kg/hour
Titrate to range of 0.1–2 mcg/kg/hour
**Note: higher dosage range in burn patients
C: NS, D5W, Ringer’s and Lactated Ringer’s, aminophylline, amiodarone, ampicillin, azithromycin, cefazolin, cefotaxime, digoxin, dopamine, epinephrine, esmolol, fluconazole, furosemide, gentamicin, heparin, hydromorphone, ketorolac, labetalol, lorazepam, magnesium sulphate, methylprednisolone, milrinone, norepinephrine, piperacillin-tazobactam, potassium chloride, ranitidine, sodium bicarbonate, sodium nitroprusside, vancomycin
I: amphotericin B, diazepam
· Use caution when administering loading dose as rapid rate of infusion is associated with increased adverse cardiovascular effects (including hypotension, bradycardia and
cardiac arrest)
· Hypotension and bradycardia may be treated by stopping or decreasing the infusion, administration of atropine or glycopyrrolate, increasing the rate of IV fluid administration, use of vasopressor agents and elevation of lower extremities.
· Change solution at 48 hours.
· Ref: 1, 2, 3
Drug
Concentrations
Infusion Rate
Dose Range
Y-Site Compatibility
Comments
Dobutamine
[Dobutrex]
250 mg/20 mL vial (12.5 mg/mL)
pH = 2.5 – 5
Osmolality = 276
Contains EDTA & metabisulfite
Revised
Feb 2020
Standard Concentrations
patients < 6 kg:
2000 mcg/mL
(2 mg/mL)
Add 4 mL of
12.5 mg/mL to
21 mL D5W to make 25 mL of 2000 mcg/mL
patients > 6 kg:
5000 mcg/mL
(5 mg/mL)
Add 20 mL of
12.5 mg/mL to
30 mL D5W to make 50 mL of 5000 mcg/mL
Use Alaris Pump to determine infusion rate.
AND
Confirm with the following calculation:
Infusion rate (mL/h) = Dose (mcg/kg/min)
x Weight (kg)
x 60 (min/h)
divided by
Concentration (mcg/mL)
Hypotension
2 – 20 mcg/kg/min
Maximum Dose
40 mcg/kg/min (toxicity may occur)
C: D5W, D10W, NS, D5LR, D5NS, alprostadil, amiodarone, calcium, dopamine, epinephrine, fentanyl, hydromorphone, insulin, isoproterenol, labetalol, lidocaine, magnesium sulfate, milrinone, morphine, nitroglycerin, nitroprusside, norepinephrine, potassium chloride, propofol
I: aminophylline, alteplase, furosemide, heparin, midazolam, potassium phosphate, sodium bicarbonate, alkaline solutions, diluents containing bisulfite, ethanol
Compatible with TPN
· Central line administration preferred.
· Peripheral line administration may be used for rates < 5 mcg/kg/min.
· Extravasation may cause sloughing or necrosis.
· Tachycardia, arrhythmias, hypertension at higher doses.
· Protect from light.
· Pink discoloration of solution may occur – do not need to discard.
· Change solution at 96 hours.
· Ref: 1, 3, 6, 7
Drug
Concentrations
Infusion Rate
Dose Range
Y-Site Compatibility
Comments
Dopamine
[Intropin]
40 mg/mL (5 mL), 1.6 or 3.2 mg/mL (250 mL)
pH = 2.5 – 4.5
Osmolality =
619 (40 mg/mL)
295 (3.2 mg/mL)
Revised Nov 2013
Reviewed Feb 2020
Standard Concentrations
commercially available:
1600 mcg/mL
3200 mcg/mL
Use Alaris Pump to determine infusion rate.
AND
Confirm with the following calculation:
Infusion rate (mL/h) = Dose (mcg/kg/min)
x Weight (kg)
x 60 (min/h)
divided by
Concentration (mcg/mL)
Hypotension
2 – 20 mcg/kg/min
Dopaminergic (contractility):
< 5 mcg/kg/min
Beta-Adrenergic
(increased HR):
5 – 15 mcg/kg/min
Alpha-Adrenergic
(vasoconstriction):
>15 mcg/kg/min
Maximum Dose
50 mcg/kg/min
C: D5W, D10W, NS, D5LR, Ringer’s Lactate, amiodarone, aminophylline, calcium, dobutamine, epinephrine, fentanyl, heparin, isoproterenol, labetalol, lidocaine, lorazepam, magnesium, mannitol, midazolam, milrinone, morphine, nitroglycerin, nitroprusside, norepinephrine, propofol, potassium chloride, potassium phosphate
I: alteplase, furosemide, insulin, phenytoin, sodium bicarbonate, thiopental, iron salts, oxidizing agents, alkaline solutions
Compatible with TPN
· Central line administration preferred.
· Do not infuse via umbilical artery catheter.
· May be prepared as 250 or 500 mL PVC containers when required (if rate > 5mL/hour). Request from pharmacy.
· Extravasation may cause ischemia or tissue necrosis.
· In case of infiltration, notify physician immediately to initiate phentolamine protocol.
· Adverse effects include tachycardia, arrhythmia, hypotension, hypertension, peripheral gangrene.
· Discard solution if yellow-brown discoloration occurs.
· Change solution at 96 hours.
· Ref: 1, 2, 3, 7
Drug
Concentrations
Infusion Rate
Dose Range
Y-Site Compatibility
Comments
Epinephrine
[Adrenalin]
1:1000 (1 mg/mL)
1:10,000
(0.1 mg/mL)
pH = 2.5 – 5
Osmolality =
348 (1:1000)
273 (1:10,000)
Revised Jun 2020
Standard Concentrations
25 mcg/mL
Add 0.63 mL of 1 mg/mL (1:1000) to 24.37 mL D5W or NS to make 25 mL of 25 mcg/mL
50 mcg/mL
Add 2.5 mL of 1 mg/mL (1:1000) to 47.5 mL D5W or NS to make 50 mL of 50 mcg/mL
100 mcg/mL
Add 5 mL of 1 mg/mL (1:1000) to 45 mL D5W or NS to make 50mL of 100 mcg/mL
Use Alaris Pump to determine infusion rate.
AND
Confirm with the following calculation:
Infusion rate (mL/h) = Dose (mcg/kg/min)
x Weight (kg)
x 60 (min/h)
divided by
Concentration (mcg/mL)
Circulatory Support After Volume Resuscitation
0.01 – 1 mcg/kg/min
Beta-adrenergic (inotropy & vasodilation):
<0.2 mcg/kg/min
Alpha-adrenergic (vasoconstriction):
>0.2 mcg/kg/min
C: D5W, D10W, NS, D5NS, D5LR, dobutamine, dopamine, fentanyl, furosemide, heparin, hydromorphone, labetalol, lidocaine, lorazepam, midazolam, milrinone, morphine, nitroglycerin, norepinephrine, potassium chloride, propofol
I: aminophylline, calcium, sodium bicarbonate, thiopental
Compatible with TPN
· Central line administration preferred.
· Extravasation may cause ischemia or tissue necrosis
· In case of infiltration, notify physician immediately to initiate phentolamine protocol.
· May be prepared as 250 or 500 mL PVC containers when required (if rate > 5mL/hour). Request from pharmacy.
· Adverse effects include tachycardia, dysrhythmias, myocardial ischemia, hypertension.
· Protect from light.
· Discard solution if precipitation or pink or brown discoloration occurs.
· Change solution at 96 hours.
· Ref: 3, 4, 7
Drug
Concentrations
Infusion Rate
Dose Range
Y-Site Compatibility
Comments
Epoprostenol
[Prostacyclin, Flolan, PG-12]
500 mcg vial with
5 mL diluent
pH = 10.2
Revised April 2008
Reviewed Feb 2020
Standard Concentration
10 mcg/mL
Add 2.5 mL of
100 mcg/mL to
22.5 mL D5W to make 25 mL of
10 mcg/mL
Use Alaris Pump to determine infusion rate.
AND
Confirm with the following calculation:
Infusion rate (mL/h) = Dose (ng/kg/min)
x Weight (kg)
x 60 (min/h)
divided by
Concentration (mcg/mL)
divided by
1000 (ng/mcg)
Pulmonary Hypertension
Note: doses are in nanograms
(1 mcg = 1000 ng)
2 – 60 ng/kg/min
Start at 2 ng/kg/min and increase by
2 ng/kg/min every 15 min until desired response is achieved or adverse effects appear.
Maximum Dose
120 ng/kg/min
C: diluent supplied, sodium chloride (0.45% or 0.9%); limited data to support co-infusion with heparin 1 unit/mL in NaCl 0.45%
I: all medications & other solutions
Incompatible with TPN
· Central line administration preferred.
· Reconstitution: inject diluent slowly down side of vial to avoid foaming. Do not shake the vial.
· Light-protected solution is stable for 48 hours if refrigerated, or for 8 hours at room temperature.
· Pharmacy will supply 3 syringes per day – store in refrigerator until use.
· Do not abruptly discontinue the infusion. Have an extra syringe available at all times in case of pump or syringe failure.
· Adverse effects include hypotension and tachycardia. Bleeding may occur at higher doses (>20 ng/kg/min) due to platelet inhibition.
· Protect syringe and tubing from light.
· Change solution every 8 hours.
· Ref: 1, 3, 10, 11
Drug
Concentrations
Infusion Rate
Dose Range
Y-Site Compatibility
Comments
Esmolol
[Brevibloc]
100 mg/10 mL
pH = 4.5 – 5.5
Revised Feb 2020
Standard Concentration
10 mg/mL
(undiluted)
Use Alaris Pump to determine infusion rate.
AND
Confirm with the following calculation:
Infusion rate (mL/h) = Dose (mcg/kg/min)
x Weight (kg)
x 60 (min/h)
divided by
Concentration (mg/mL)
divided by 1000 (mcg/mg)
Hypertension
50 – 300 mcg/kg/min
Maximum Dose
1000 mcg/kg/min
Supraventricular Tachycardia
500 – 600 mcg/kg IV loading dose over
1 – 2 min, followed by 200 mcg/kg/min infusion. Titrate by
50 – 100 mcg/kg/min every 5 – 10 min until a 10% reduction in heart rate and blood pressure occurs.
Postoperative Hypertension
Loading dose as for SVT, followed by 100 – 500 mcg/kg/min infusion. Titrate as for SVT.
C: D5W, NS, D5NS, D5LR, amiodarone, calcium, dopamine, fentanyl, heparin, insulin, lidocaine, midazolam, morphine, nitroglycerin, nitroprusside, potassium chloride, propofol
I: diazepam, furosemide, procainamide, sodium bicarbonate, thiopental, strong acids or bases
Compatible with TPN
· Monitor heart rate, blood pressure, ECG, respiratory rate continuously.
· A 10% decrease in heart rate or MAP signifies beta blockade.
· Effects will last 2 – 16 minutes after infusion stopped.
· Avoid abrupt discontinuation as acute tachycardia, hypertension and/or ischemia may occur
· Change solution at 96 hours
· Ref: 1, 2, 3, 4, 7
Drug
Concentrations
Infusion Rate
Dose Range
Y-Site Compatibility
Comments
Fentanyl
[Sublimaze]
10 mcg/mL in 250 mL bag
50 mcg/mL in 2, 5 or 20 mL vials
pH = 4.7 – 5
Osmolality = 0
Revised Nov 2013
Reviewed Feb 2020
Standard Concentrations
patient 2 - 6 kg:
10 mcg/mL
(undiluted)
patient 6- 30 kg:
25 mcg/mL
Add 25 mL of
50 mcg/mL to 25 mL NS to make 50 mL of
25 mcg/mL
patient 30-120 kg:
50 mcg/mL
(undiluted)
Use Alaris Pump to determine infusion rate.
AND
Confirm with the following calculation:
Infusion rate (mL/h) = Dose (mcg/kg/h)
x Weight (kg)
divided by
Concentration (mcg/mL)
Sedation & Analgesia
Infants & Children
1 – 2 mcg/kg slow IV bolus over 3 – 5 min, followed by
1 – 5 mcg/kg/h
Extracorporeal Membrane Oxygenation
5 – 10 mcg/kg slow IV bolus over 10 min, followed by 5 – 20 mcg/kg/h
C: D5W, NS, lactated Ringers, aminophylline, calcium chloride, calcium gluconate, dobutamine, dopamine, epinephrine, esmolol, furosemide, heparin, insulin, isoproterenol, hydromorphone, labetalol, lidocaine, lorazepam, magnesium, midazolam, milrinone, morphine, nitroglycerin, nitroprusside, norepinephrine, propofol, potassium chloride, sodium bicarbonate, vasopressin
I: amphotericin, phenytoin
Compatible with TPN
· Peripheral or central line administration.
· Higher doses may be required in ECMO as the drug is sequestered by the circuit. Morphine is the preferred opiate for continuous analgesia and sedation in ECMO.
· Chest rigidity may occur with large loading doses (>5 mcg/kg) and is reversible with naloxone.
· Monitor for respiratory depression in non-ventilated patients.
· Antidote is naloxone 0.01 – 0.1 mg/kg IV prn
· Change solution at 96 hours.
· Ref: 2, 3, 7
Drug
Concentrations
Infusion Rate
Dose Range
Y-Site Compatibility
Comments
Furosemide
[Lasix]
10 mg/mL
pH = 8.5 – 9.3
Osmolality = 290
Revised Feb 2020
Standard Concentrations
1 mg/mL
Add 5 mL of 10 mg/mL to 45 mL of NS to make 50 mL
of 1 mg/mL
2 mg/mL
Add 10 mL of
10 mg/mL to
40 mL NS to make 50 mL
of 2 mg/mL
10 mg/mL
(undiluted)
central line only
Use Alaris Pump to determine infusion rate.
AND
Confirm with the following calculation:
Infusion rate (mL/h) = Dose (mg/kg/h)
x Weight (kg)
divided by
Concentration (mg/mL)
Diuresis
0.1 – 1 mg/kg/h
Maximum Dose
4 mg/min OR
0.5 mg/kg/min
C: D5W, D10W, NS, Ringer’s Lactate, D5LR, aminophylline, calcium gluconate, epinephrine, fentanyl, heparin, hydromorphone, hydrocortisone, lidocaine, lorazepam, nitroglycerin, norepinephrine, sodium bicarbonate, propofol, potassium chloride
I: acidic solutions, amiodarone, amphotericin, dobutamine, esmolol, isoproterenol, labetalol midazolam, milrinone, morphine, thiopental
Incompatible with TPN
· Central line administration for concentrations > 5 mg/mL
· Increased risk of electrolyte abnormalities with continuous infusions.
· Rapid administration may cuase transient or permanent ototoxicity . Concurrent aminoglycosides potentiate this risk.
· Contraindicated in anuria.
· Discard discolored solutions.
· Protect from light.
· Change solution at 24 hours (light exposed) or 96 hours (light protected).
· Ref: 1, 3, 7, 9
Drug
Concentrations
Infusion Rate
Dose Range
Y-Site Compatibility
Comments
Heparin
[Heparin Sodium]
25,000 units/500 mL
bag (50 IU/mL)
10,000 units/10 mL
vial (1000 IU/mL)
pH = 5 – 7.5
Osmolality = 280 –
380 (100 IU/mL)
May contain sulfites and benzyl alcohol
Revised Feb 2020
Standard Concentrations
50 units/mL
(draw up from commercially available bag 25,000 units/
500 mL D5W)
Fluid-Restricted:
100 units/mL
(draw up from commercially available bag 50,000 units/
500 mL D5W)
Use Alaris Pump to determine infusion rate.
AND
Confirm with the following calculation:
Infusion rate (mL/h) = Dose (units/kg/h)
x Weight (kg)
divided by
Concentration (units/mL)
Consult Heparin Protocol in BCCH Pediatric Drug Dosage Guidelines
Therapeutic Heparinization
75 units/kg IV loading dose (max 5000 units) over 10 minutes, followed by:
<1 year:
28 units/kg/h
>1 year:
20 units/kg/h
Adjust rate based on PTT results
C: D5W, NS, D5LR, alprostadil, aminophylline, calcium chloride, calcium gluconate, dopamine, epinephrine, esmolol, fentanyl, furosemide, hydromorphone, insulin, isoproterenol, labetalol, lidocaine, lorazepam, magnesium midazolam, milrinone, morphine, nitroglycerin, norepinephrine, potassium chloride, propofol, sodium bicarbonate, thiopental
I: alteplase, amiodarone, diazepam, dobutamine
Compatible with TPN
· Peripheral or central line administration.
· See Heparin Protocol in BCCH Pediatric Drug Dosage Guidelines, 2018 (Esau, ed)
· Change solution and tubing at 72 hours.
· Ref: 1, 2, 3, 5, 7
Drug
Concentrations
Infusion Rate
Dose Range
Y-Site Compatibility
Comments
Hydromorphone
[Dilaudid]
2 mg/mL
pH = 4 – 5.5
Revised May 2015
Reviewed Feb 2020
Standard Concentrations
40 mcg/mL
Add 0.5 mL of
2 mg/mL to
24.5 mL D5W or NS to make 25 mL of
40 mcg/mL
80 mcg/mL
Add 2 mL of
2 mg/mL to
48 mL D5W or NS to make 50 mL of 80 mcg/mL
200 mcg/mL
Add 5 mL of
2 mg/mL to
45 mL D5W or NS to make 50 mL of 200 mcg/mL
Use Alaris Pump to determine infusion rate.
AND
Confirm with the following calculation:
Infusion rate (mL/h) = Dose (mcg/kg/h)
x Weight (kg)
divided by
Concentration (mcg/mL)
Postoperative Analgesia & Sedation
1 – 8 mcg/kg/h
Severe pain may require much higher doses.
C: D5W, NS, D5NS, D5LR, dobutamine, dopamine, epinephrine, fentanyl, furosemide, heparin, ketamine, labetolol, lorazepam, magnesium, midazolam, milrinone, morphine, nitroglycerin, norepinephrine, propofol
I: phenobarbital, phenytoin, sodium bicarbonate, thiopental
· Peripheral or central line administration.
· CAUTION: Hydromorphone is 5X more potent than morphine.
· Semi-synthetic opiate analgesic indicated in patients with an allergy or intolerance to morphine.
· Prolonged use of a high-dose infusion may result in tolerance.
· Abrupt discontinuation after prolonged use (>2 weeks) may result in withdrawal.
· Monitor for respiratory depression in non-ventilated patients.
· Antidote is naloxone 0.01 mg/kg IV
· Not recommended in neonates.
· Change solution at 96 hours.
· Ref: 3, 6, 7
Drug
Concentrations
Infusion Rate
Dose Range
Y-Site Compatibility
Comments
Insulin, Regular
[Humulin]
1000 units/10 mL
vial (100 U/mL)
pH = 7 – 7.8
Revised January 2020
Standard Concentrations
For DKA patients:
0.1 unit/mL
Add 0.5 mL of
100 U/mL to
500 mL NS to make 500 mL of
0.1 unit/mL
For fluid restricted patients:
0.5 units/mL
Add 0.25 mL of 100 U/mL to
49.75 mL NS to make 50 mL of 0.5 units/mL
Use Alaris Pump to determine infusion rate.
AND
Confirm with the following calculation:
Infusion rate (mL/h) = Dose (units/kg/h)
x Weight (kg)
divided by
Concentration (units/mL)
Diabetic Ketoacidosis (DKA)
0.05 – 0.2 unit/kg/h
Glucose Intolerance
0.03 – 0.05 unit/kg/h
Adjust rate to desired blood glucose concentration.
Hyperkalemia
0.05 – 0.1 unit/kg/h
Infused with glucose 400 mg/kg (or 4 g for every 1 unit insulin)
C: D5W, NS, amiodarone, calcium gluconate, dobutamine, esmolol, heparin, magnesium midazolam, milrinone, morphine, nitroglycerin, nitroprusside, potassium chloride, propofol, sodium bicarbonate
I: aminophylline, dopamine, norepinephrine
Compatible with TPN
· Peripheral or central line administration.
· Titrate infusion rate to desired blood glucose concentration.
· Monitor closely for hypoglycemia.
· Only Human Regular insulin is to be given intravenously.
· Pre-flush tubing with twice the volume of tubing dead space.
· Higher concentrations to be used only for fluid-restricted patients.
· Change solution and tubing at 24 hours.
· Ref: 1, 2, 7
Drug
Concentrations
Infusion Rate
Dose Range
Y-Site Compatibility
Comments
Isoproterenol
[Isuprel]
1:5000 (0.2 mg/mL)
1 mL ampule
pH = 3.5 – 4.5
Osmolality = 277
Contains sodium chloride, sodium lactate, lactic acid, metabisulfite
Revised Feb 2020
Standard Concentrations
25 mcg/mL
Add 6.25 mL of 0.2 mg/mL (1:5000) to
43.75 mL D5W to make 50 mL of
25 mcg/mL
50 mcg/mL
Add 12.5 mL of 0.2 mg/mL (1:5000) to
37.5 mL D5W to make 50 mL of
50 mcg/mL
100 mcg/mL
Add 25 mL of 0.2 mg/mL (1:5000) to 25 mL D5W to make
50 mL of
100 mcg/mL
Use Alaris Pump to determine infusion rate.
AND
Confirm with the following calculation:
Infusion rate (mL/h) = Dose (mcg/kg/min)
x Weight (kg)
x 60 (min/h)
divided by
Concentration (mcg/mL)
Hypotension
Neonates & Children
0.025 – 2 mcg/kg/min
C: D5W, NS, D5NS, D5LR, amiodarone, calcium chloride, dobutamine, dopamine, epinephrine, fentanyl, heparin, lidocaine, magnesium, midazolam, milrinone, morphine, nitroprusside, potassium chloride, propofol
I: aminophylline, furosemide, sodium bicarbonate
Compatible with TPN
· Central line administration preferred.
· Very potent chronotrope, inotrope, and peripheral vasodilator.
· Not considered drug of choice for bradycardia.
· Do not use for digitalis toxicity.
· Significant degradation occurs above pH 6.
· Protect from light.
· Discard discolored or precipitated solutions.
· Change solution at 96 hours.
· Ref: 1, 2, 7
Drug
Concentrations
Infusion Rate
Dose Range
Y-Site Compatibility
Comments
Ketamine
[Ketalar]
10 mg/mL vial
50 mg/mL vial
pH = 3.5 – 5.5
Osmolality = 300
(10 mg/mL)
Revised Feb 2020
Standard Concentrations
patient < 70 kg:
10 mg/mL
(undiluted)
(= 10000 mcg/mL)
patient > 70 kg:
50 mg/mL
(undiluted)
**request from pharmacy
(= 50 000 mcg/mL)
Use Alaris Pump to determine infusion rate.
AND
Confirm with the calculation at bottom of page
Continuous Sedation
5 – 20 mcg/kg/min
Bronchospasm
3 – 40 mcg/kg/min
C: D5W, NS, calcium gluconate, dobutamine, dopamine, epinephrine, lidocaine, magnesium, morphine, propofol
I: Acyclovir, aminophylline, ampicillin, diazepam, furosemide, heparin, insulin, pentobarbital, salbutamol, sodium bicarbonate
· Peripheral or central line administration.
• Rapid administration may cause increased apnea, respiratory depression and enhanced pressor response.
• Emergence reactions (e.g. dream-like states, hallucinations, delirium) may occur. Minimizing verbal, tactile
and visual stimulation after dosing decreases the likelihood of these reactions.
· May see increased secretions. Glycopyrrolate may be effective in reversing some of the sialogogue effect.
· Monitor closely for transient laryngospasm, apnea, respiratory arrest.
· Change solution at 96 hours.
· Ref: 1, 2, 7
Infusion rate mL/hour = Dose (mcg/kg/min) X Weight (kg) X 60 min/hour)
Concentration (mg/mL) X 1000 mcg/mg
Drug
Concentrations
Infusion Rate
Dose Range
Y-Site Compatibility
Comments
Labetalol
[Trandate]
5 mg/mL
pH = 3 – 4
Osmolality = 287
May contain parabens
Revised Jan 2020
Standard Concentrations
1 mg/mL
Add 10 mL of
5 mg/mL to 40 mL
D5W to make
50 mL of 1 mg/mL
5 mg/mL
(undiluted)
Use Alaris Pump to determine infusion rate.
AND
Confirm with the following calculation:
Infusion rate (mL/h) = Dose (mg/kg/h)
x Weight (kg)
divided by
Concentration (mg/mL)
Hypertension
Continuous Infusion
0.25 – 3 mg/kg/h
*Increase in increments of 0.05 mg/kg/h as needed to control BP to a max of 3 mg/kg/h
May give bolus just prior to starting infusion
Hypertensive Emergencies
Intermittent Boluses 0.2 – 1 mg/kg IV over at least 2 minutes
May repeat at 10 min intervals until desired BP has been achieved
C: D5W, NS, D5NS, lactated Ringer’s, D5LR, aminophylline, amiodarone, calcium gluconate, dobutamine, dopamine, epinephrine, esmolol, fentanyl, hydromorphone, isoproterenol, lorazepam, lidocaine, magnesium sulfate, midazolam, milrinone, morphine, nitroglycerin, nitroprusside, norepinephrine, potassium chloride, potassium phosphate, propofol
I: furosemide, insulin, sodium bicarbonate, thiopental
· Peripheral or central line administration.
· Use cautiously in pediatrics: limited information on use in children.
· Alpha and beta adrenergic blocker. Contraindicated in patients with asthma, COPD, cardiac failure, heart block, bradycardia, cardiogenic shock.
· Orthostatic hypotension may occur with intravenous administration.
· Caution in hepatic dysfunction.
· Change solution at 72 hours for 1 mg/mL in D5W and at 24 hours for 1 mg/mL in NS and 96 hours for 5 mg/mL concentration.
·
· Ref: 1, 2, 3, 7
Drug
Concentrations
Infusion Rate
Dose Range
Y-Site Compatibility
Comments
Lidocaine
[Xylocaine]
20 mg/mL vial
1000 mg/250 mL
bag (4 mg/mL)
pH =
5 – 7 (20 mg/mL)
3.5 – 6 (4 mg/mL)
Osmolality =
352 (20 mg/mL)
May contain sulfites and parabens
Revised Nov 2013
Reviewed May 2020
Standard Concentrations
4 mg/mL: commercially available in 250 mL bag
-or-:
Add 10 mL of
20 mg/mL to
40 mL D5W to make 50 mL of
4 mg/mL
8 mg/mL
Add 20 mL of
20 mg/mL to
30 mL D5W to
make 50 mL of
8 mg/mL
Use Alaris Pump to determine infusion rate.
AND
Confirm with the following calculation:
Infusion rate (mL/h) = Dose (mcg/kg/min)
x Weight (kg)
x 60 (min/h)
divided by
Concentration (mg/mL)
divided by 1000 (mcg/mg)
Ventricular Arrhythmia
1 mg/kg IV loading dose over 2 – 3 min, may repeat q10min (max 5 mg/kg total), followed by
10 – 50 mcg/kg/min
C: D5W, NS, D5NS, D5LR, Ringer’s Lactate, alteplase, aminophylline, amiodarone, calcium, dobutamine, dopamine, epinephrine, esmolol, fentanyl, furosemide, heparin, isoproterenol, labetalol, morphine, nitroglycerin, nitroprusside, norepinephrine, potassium chloride, procainamide, propofol
I: sodium bicarbonate, thiopental
· Peripheral or central line administration.
· Contraindicated in infants with congenital heart disease and severe heart block.
· Decrease dose in patients with shock, CHF, liver failure or reduced hepatic blood flow.
· Therapeutic Drug Monitoring
Therapeutic range = 4.5 – 21 mcmol/L (1.5 – 5 mcg/mL)
Potentially toxic range = >26 mcmol/L (>6 mcg/mL)
Toxic range => 38 mcmol/L (>9 mcg/mL)
· Signs of toxicity include myocardial and CNS depression.
· Change solution at 96 hours.
· Ref: 1, 2, 3, 7
Drug
Concentrations
Infusion Rate
Dose Range
Y-Site Compatibility
Comments
Lorazepam
[Ativan]
4 mg/mL vials
pKa = 1.3 & 11.5
(ampholyte)
Isoelectric @ 6.4
Contains propylene glycol and benzyl alcohol
Revised April 2008
Reviewed May 2020
Standard Concentration
0.2 mg/mL
Add 2.5 mL of
4 mg/mL to
47.5 mL D5W to make 50 mL of 0.2 mg/mL
Use Alaris Pump to determine infusion rate.
AND
Confirm with the following calculation:
Infusion rate (mL/h) = Dose (mg/kg/h)
x Weight (kg)
divided by
Concentration (mg/mL)
Sedation with Mechanical Ventilation
0.01 – 0.1 mg/kg/h
Larger doses may be required in ECMO due to extraction of ~ 50% by the circuit
Maximum Dose
2 mg/h
C: D5W, amiodarone, dobutamine, dopamine, epinephrine, fentanyl, furosemide, heparin, hydromorphone, labetalol, milrinone, midazolam, morphine, norepinephrine, potassium chloride, propofol
I: sufentanil, thiopental
· Peripheral or central line administration.
· Requirements for sedation are highly variable and dose titration is necessary.
· May cause metabolic complications (lactic acidosis, hyperosmolality, increased osmolar gap) with doses >8 mg/h or nephrotoxicity due to propylene glycol content.
· Use with caution in patients with renal or hepatic impairment.
· Use D5W only for dilutions and observe frequently for precipitate.
· Store vials in refrigerator.
· Change solution at 24 hours.
· Ref: 1, 3
Drug
Concentrations
Infusion Rate
Dose Range
Y-Site Compatibility
Comments
Magnesium Sulfate
[MgSO4]
50% ( 500 mg/mL)
Each mL contains:
500 mg MgSO4
2 mmol Mg+2
4 mEq Mg+2
Osmolality =
2620 – 2875
Revised Dec 2013
Reviewed May 2020
Standard Concentrations
Neonates:
10 mg/mL
(0.04 mmol/mL)
Add 0.5 mL of 50% to 24.5 mL D5W to make
25 mL of
10 mg/mL
Non neonates:
100 mg/mL
(0.4 mmol/mL)
Add 10 mL of 50% to 40 mL D5W to make 50 mL of
100 mg/mL
Non neonates,
Fluid Restricted:
200 mg/mL
(0.8 mmol/mL)
Add 20 mL of 50% to 30 mL D5W to make 50 mL of
200 mg/mL
Use Alaris Pump to determine infusion rate.
AND
Confirm with the following calculation:
Infusion rate (mL/h) = Dose (mg/kg/day)
x Weight (kg)
divided by
Concentration (mg/mL)
divided by
24 (h/day)
OR
Infusion rate (mL/h) = Dose (mmol/kg/d)
x Weight (kg)
divided by
Concentration (mmol/mL)
divided by
24 (h/day)
Maximum Rate
150 mg/min
Postoperative Cardiac Patients
0.2 – 0.8 mmol/kg/day
Hypomagnesemia
25 – 50 mg/kg/dose (0.1 – 0.2 mmol/kg) IV q6h x 3 – 4 doses
C: D5W, NS, aminophylline, dobutamine, dopamine, epinephrine, fentanyl, heparin, hydromorphone, insulin, isoproterenol, labetalol, milrinone, morphine, nitroprusside, norepinephrine, potassium chloride, propofol
I: amiodarone, calcium chloride, calcium gluconate, lipid emulsion, sodium bicarbonate
Compatible with TPN
· Peripheral or central line administration.
· Monitor serum magnesium levels daily while on infusion (Normal Range = 0.78 – 1.03 mmol/L)
· Usual duration of infusion is 1 – 2 days.
· Signs of toxicity include respiratory depression or heart block. Toxicity is reversed using calcium gluconate.
· Renal impairment will increase risk of toxicity.
· Change solution at 24 hours.
· Ref: 1, 3, 6
Drug
Concentrations
Infusion Rate
Dose Range
Y-Site Compatibility
Comments
Midazolam
[Versed]
5 mg/mL in 2 or
10 mL vial
1 mg/1 mL vial
pH = 3 – 3.6
Osmolality = 385
Contains benzyl alcohol
Revised Dec 2013
Reviewed May 2020
Standard Concentrations
1 mg/mL
Add 10 mL of
5 mg/mL to 40 mL D5W or NS to make
50 mL of
1 mg/mL
Fluid Restriction:
5 mg/mL
(undiluted from 5 mg/mL strength vials)
Use Alaris Pump to determine infusion rate.
AND
Confirm with the calculation below.
Sedation in Mechanical Ventilation
20 – 360 mcg/kg/h
(0.33 – 6 mcg/kg/min)*
Loading Dose
0.05 – 0.2 mg/kg IV over at least
3 minutes
* Note:
20 mcg/kg/h = 0.33 mcg/kg/min
30 mcg/kg/h = 0.5 mcg/kg/min
60 mcg/kg/h = 1 mcg/kg/min
100 mcg/kg/h = 1.7 mcg/kg/min
120 mcg/kg/h = 2 mcg/kg/min
150 mcg/kg/h = 2.5 mcg/kg/min
180 mcg/kg/h = 3 mcg/kg/min
210 mcg/kg/h = 3.5 mcg/kg/min
240 mcg/kg/h = 4 mcg/kg/min
360 mcg/kg/h = 6 mcg/kg/min
C: D5W, NS, D5NS, amiodarone, calcium gluconate, dobutamine, dopamine, epinephrine, esmolol, fentanyl, heparin, hydromorphone, insulin, labetalol, magnesium, milrinone, morphine, nitroglycerin, norepinephrine, potassium chloride, propofol
I: amphotericin, furosemide, hydrocortisone, omeprazole, sodium bicarbonate, thiopental
Compatible with TPN
· Peripheral or central line administration.
· Use lowest effective dose, as may accumulate in tissues with prolonged use.
· May cause hypotension. Use cautiously and avoid loading doses in postoperative open-heart patients, septic shock, or meningococcemia.
· Rapid infusion may cause respiratory depression or apnea.
· Change solution at 96 hours.
· Ref: 1, 2, 3, 7
Infusion rate (mL/hour) = _____dose (mcg/kg/hour) X weight (kg)_______
Concentration (mg/mL) X 1000mcg/mg
Drug
Concentrations
Infusion Rate
Dose Range
Y-Site Compatibility
Comments
Milrinone
[Primacor]
1 mg/mL
pH = 3.2 – 4
Contains lactic acid (0.93 – 1.29 mg/mL)
Revised Jan 2020
Standard Concentrations
patient 2 - 6 kg:
100 mcg/mL
Add 2.5 mL of
1 mg/mL to
22.5 mL D5W to make 25 mL of
100 mcg/mL
patient 6- 30 kg:
200 mcg/mL
Add 10 mL of
1 mg/mL to
40 mL D5W to make 50 mL of
200 mcg/mL
patient 30-120 kg:
400 mcg/mL
Add 20 mL of
1 mg/mL to
30 mL D5W to make 50 mL of 400 mcg/mL
Use Alaris Pump to determine infusion rate.
AND
Confirm with the following calculation:
Infusion rate (mL/h) = Dose (mcg/kg/min)
x Weight (kg)
x 60 (min/h)
divided by
Concentration (mcg/mL)
Postoperative Cardiac Patients
50 mcg/kg IV loading dose over 10 min, followed by
0.25 – 0.75 mcg/kg/min
Maximum Dose
1 mcg/kg/min
C: D5W, NS, amiodarone, calcium chloride, dobutamine, dopamine, epinephrine, fentanyl, heparin, hydromorphone, insulin, labetalol, lorazepam, magnesium sulfate, midazolam, morphine, nitroglycerin, norepinephrine, potassium chloride, propofol, sodium bicarbonate, thiopental
I: furosemide, procainamide,
· Peripheral or central line administration.
· Loading doses require the approval of a pediatric intensivist due to risk of significant hypotension.
· May be prepared as 250 or 500 mL PVC containers when required (if rate > 5mL/hour). Request from pharmacy.
· Half-life is prolonged in renal failure.
· Adverse effects include hypotension, arrhythmias, bronchospasm.
· Change solution at 96 hours.
· Ref: 1, 2, 3, 7
Drug
Concentrations
Infusion Rate
Dose Range
Y-Site Compatibility
Comments
Morphine
[MOS]
10 mg/mL
pH = 2.5 – 6
Osmolality = 54
Revised Feb 2020
Standard Concentrations
200 mcg/mL
Add 0.5 mL of
10 mg/mL to
24.5 mL D5W or NS to make 25 mL of 200 mcg/mL
400 mcg/mL
Add 2 mL of
10 mg/mL to
48 mL NS or D5W to make 50 mL of
400 mcg/mL
1 mg/mL
(=1000 mcg/mL)
Add 5 mL of
10 mg/mL to
45 mL NS or D5W to make 50 mL of
1 mg/mL
Use Alaris Pump to determine infusion rate.
AND
Confirm with the following calculation:
Infusion rate (mL/h) = Dose (mcg/kg/h)
x Weight (kg)
divided by
Concentration (mcg/mL)
Postoperative Analgesia & Sedation
5 – 20 mcg/kg/h
C: D5W, NS,D5NS, D51/2NS, D5LR, , aminophylline, amiodarone, calcium chloride, calcium gluconate, dopamine, dobutamine, epinephrine, esmolol, fentanyl, heparin, hydromorphone, insulin, ketamine, labetalol, lidocaine, magnesium sulfate, midazolam, milrinone, nitroglycerin, nitroprusside, norepinephrine, potassium chloride
I: amphotericin, furosemide
Compatible with TPN
· Peripheral or central line administration.
· Monitor for respiratory depression in non-ventilated patients.
· Antidote is naloxone 0.01 – 0.1 mg/kg IV prn
· Prolonged use of high-dose infusion may result in tolerance.
· Abrupt discontinuation of infusion after prolonged use (>2 weeks) may result in withdrawal symptoms.
· Change solution at 96 hours.
· Ref: 1, 2, 3, 7
Drug
Concentrations
Infusion Rate
Dose Range
Y-Site Compatibility
Comments
Nitroglycerin
[Nitrostat, NTG]
5 mg/mL
pH = 3 – 6.5
Osmolality = 281
(1 mg/mL)
Contains propylene glycol and ethanol
Revised Dec 2013
Reviewed May 2020
Standard Concentrations
100 mcg/mL
Add 0.5 mL of
5 mg/mL to
24.5 mL D5W to make 25 mL of
100 mcg/mL
200 mcg/mL
Add 2 mL of
5 mg/mL to 48 mL D5W to make
50 mL of
200 mcg/mL
500 mcg/mL
Add 5 mL of
5 mg/mL to
45 mL D5W to make 50 mL of
500 mcg/mL
Use Alaris Pump to determine infusion rate.
AND
Confirm with the following calculation:
Infusion rate (mL/h) = Dose (mcg/kg/min)
x Weight (kg)
x 60 (min/h)
divided by
Concentration (mcg/mL)
Postoperative Cardiac Patients
Pediatric
0.5 – 10 mcg/kg/min
Start at
0.1 – 1 mcg/kg/min and increase by
0.5 – 1 mcg/kg/min every 3 – 5 min until desired clinical effect
Adults
5 – 100 mcg/min
Start at 5 mcg/min and increase by
5 – 10 mcg/min until desired clinical effect
C: D5W, NS, D5LR, aminophylline, amiodarone, dobutamine, dopamine, epinephrine, esmolol, fentanyl, furosemide, heparin, hydromorphone, insulin, labetalol, lidocaine, lorazepam, midazolam, milrinone, morphine, nitroprusside, norepinephrine, propofol
I: lipid emulsion
Compatible with TPN
· Peripheral or central line administration.
· Administer via syringe pump with non-PVC tubing. Do not use a filter.
· Precipitation may occur at concentrations > 500 mcg/mL
· Adverse effects include severe hypotension and shock. Methemoglobinemia is observed in adults who receive > 7 mcg/kg/min.
· Change solution at 24 hours.
· Ref: 1, 3, 7
Drug
Concentrations
Infusion Rate
Dose Range
Y-Site Compatibility
Comments
Nitroprusside
[Nipride, Nitropress, Sodium Nitroprusside, SNP]
50 mg/2 mL vial
(25 mg/mL)
pH = 3.5 – 6
Osmolality = 214
Reconstituted solutions are colored straw/pink to reddish-brown
Revised June 2020
Standard Concentrations
200 mcg/mL
Add 0.4 mL of
25 mg/mL to
49.6 mL D5W or NS to make 50 mL of 200 mcg/mL
800 mcg/mL
Add 1.6 mL of 25 mg/mL to 48.4 mL D5W or NS to make 50 mL of 800 mcg/mL
2000 mcg/mL
Add 4 mL of
25 mg/mL to
46 mL D5W or NS to make 50 mL of 2000 mcg/mL
5000 mcg/mL
Add 10 mL of
25 mg/mL to
40 mL D5W or NS to make 50 mL of 5000 mcg/mL
Use Alaris Pump to determine infusion rate.
AND
Confirm with the following calculation:
Infusion rate (mL/h) = Dose (mcg/kg/min)
x Weight (kg)
x 60 (min/h)
divided by
Concentration (mcg/mL)
Hypertensive Crisis or Postoperative Cardiac Patients
Neonates
Start at 0.025 – 0.5 mcg/kg/min to max
6 mcg/kg/min
Pediatric
Start at
0.25 mcg/kg/min and titrate by
0.25 mcg/kg/min to max 8 mcg/kg/min
C: D5W, NS, amiodarone, dobutamine, dopamine, esmolol, heparin, insulin, labetalol, lidocaine, milrinone, morphine, nitroglycerin, potassium chloride, procainamide, propofol
I: norepinephrine, lipid emulsion
Compatible with TPN
· Peripheral or central line administration.
· Protect solution from light with aluminum foil. Not necessary to cover tubing.
· Hypotension may occur. Monitor blood pressure continuously.
· Methemoglobinuria can occur at doses > 10 mcg/kg/min. Methylene blue is used as an antidote.
· Check thiocyanate levels with high doses, prolonged use (>48h) or renal failure.
· Avoid rapid dose escalation.
· Use cautiously in patients with increased intracranial pressure.
· Discard solution if blue discoloration occurs.
· Change solution at 24 hours.
· Ref: 1, 7
Drug
Concentrations
Infusion Rate
Dose Range
Y-Site Compatibility
Comments
Norepinephrine
[Noradrenalin]
4 mg (base)/4 mL
ampoule
pH = 3 – 4.5
Osmolality = 319
Contains metabisulfite
All calculations are based on norepinephrine base ( 1 mg base = 2 mg bitartrate)
Revised January 2020
Standard Concentrations
25 mcg/mL
Add 0.63 mL of
1 mg/mL to
24.37 mL D5W or NS to make 25 mL of
25 mcg/mL
50 mcg/mL
Add 2.5 mL of
1 mg/mL to
47.5 mL D5W or NS to make 50mL of 50 mcg/mL
200 mcg/mL
Add 10 mL of
1 mg/mL to
40 mL D5W or NS to make 50 mL of
200 mcg/mL
Fluid Restricted and >30 kg:
500 mcg/mL
Add 25 mL of
1 mg/mL to
25 mL D5W or NS to make 50 mL of
500 mcg/mL
Use Alaris Pump to determine infusion rate.
AND
Confirm with the following calculation:
Infusion rate (mL/h) = Dose (mcg/kg/min)
x Weight (kg)
x 60 (min/h)
divided by
Concentration (mcg/mL)
Blood Pressure Support
Infants & Children
0.02 – 0.4 mcg/kg/min
titrated to maximum
1 mcg/kg/min
C: D5W, NS, D5NS, amiodarone, calcium chloride, calcium gluconate, dobutamine, dopamine, epinephrine, esmolol, fentanyl, furosemide, heparin, hydromorphone, labetalol, magnesium , lorazepam, midazolam, milrinone, morphine, nitroglycerin, potassium chloride, propofol, vecuronium
I: aminophylline, insulin, sodium bicarbonate, thiopental
Compatible with TPN
· Central line administration preferred.
· Dextrose-containing solutions protect from oxidation and are the preferred diluent over sodium chloride-containing solutions (NS).
· Correct intravascular volume before initiating norepinephrine.
· Extravasation may cause local ischemia and tissue necrosis.
· Notify physician in case of infiltration to initiate phentolamine protocol.
· Protect from light.
· Discard solution if brown discoloration occurs.
· Change solution at 96 hours.
· Ref: 1, 3, 7
Drug
Concentrations
Infusion Rate
Dose Range
Y-Site Compatibility
Comments
Papaverine HCl
32.5 mg/mL (2mL)
Revised Nov 2013
Reviewed May 2020
Standard Concentration:
0.12 mg/mL:
Add 1.8 mL (60 mg of 32.5 mg/mL) to 500 mL heparin 2U/mL in NS or 1/2NS to make 500 mL of
0.12 mg/mL
To prolong life of arterial catheters in neonates and infants:
< 20 kg:
Infuse in arterial line at 1 mL/hour
Prolongation life of arterial catheters in neonates and infants:
0.12 mg/hour CIVI
Not applicable. Other medications should not be infused into arterial line.
Note: at higher concentrations papaverine & heparin are incompatible. Therefore when withdrawing from the papaverine-heparin bag, use a new syringe. If residual higher concentration of the papaverine remains in the syringe, the solution will precipitate and result in a cloudy mixture.
· Note: At higher concentrations, administration by rapid IV push may cause arrhythmias, apnea, or death. If need to give IV push, administer over 1-2 minutes.
· Discard solution if solution remains cloudy after mixing.
· Change solution at 96 hours.
· Ref: 1, 3, 12
Drug
Concentrations
Infusion Rate
Dose Range
Y-Site Compatibility
Comments
Phenylephrine
10 mg/mL (1 mL, 5 mL, 10 mL vials)
Contains sulphites and sodium benzoate
Created July 2015
Reviewed May 2020
Standard Concentrations:
40 mcg/mL:
Add 0.1 mL of 10 mg/mL to 24.9 mL D5W or NS to make 25 mL of 40 mcg/mL
100 mcg/mL:
Add 0.25 mL of 10 mg/mL to 24.75 mL D5W or NS to make 25 mL of 100 mcg/mL
Use Alaris Pump to determine infusion rate.
AND
Confirm with the following calculation:
Infusion rate (mL/h) = Dose (mcg/kg/min)
x Weight (kg) X 60 (min/h)
divided by
Concentration (mcg/mL)
Hypotension/shock:
IV bolus: 5-20 mcg/kg IV q10-15 min PRN
IV infusion:
0.1- 0.5 mcg/kg/min titrated to effect
C: D5W, NS, D5NS, D51/2NS, D5LR, aminophylline, amiodarone, calcium chloride, calcium gluconate, cisatracurium, midazolam, morphine
I: acyclovir, phenytoin
Incompatible with TPN
· Central line administration.
· Do not use if solution turns brown.
· Selective alpha agonist
· Extravasation may cause local ischemia and tissue necrosis.
· Notify physician in case of infiltration to initiate phentolamine protocol.
· Change solution at 96 hours.
· Ref: 3
Drug
Concentrations
Infusion Rate
Dose Range
Y-Site Compatibility
Comments
Procainamide
[Pronestyl, PCA]
100 mg/mL
pH = 4 – 6
Osmolality = 2000
May contain sulfites and benzyl alcohol
Revised Dec 2013
Reviewed May 2020
Standard Concentrations
patient < 30 kg:
10 mg/mL
Add 5 mL of
100 mg/mL to
45 mL NS to make 50 mL of 10 mg/mL
patient > 30 kg:
30 mg/mL
Add 15 mL of
100 mg/mL to
35 mL NS to make 50 mL of 30 mg/mL
**Note: mix in NS
Use Alaris Pump to determine infusion rate.
AND
Confirm with the following calculation:
Infusion rate (mL/h) = Dose (mcg/kg/min)
x Weight (kg)
x 60 (min/h)
divided by
Concentration (mcg/mL)
Cardiac Arrhythmias
20 – 80 mcg/kg/min
Loading dose:
2 – 5 mg/kg (max 100 mg) over 5 min, may repeat q5min to a max of 15 mg/kg in 30 minutes
C: D5W, NS, calcium gluconate, dobutamine, esmolol (in D5W), heparin, lidocaine, potassium chloride, sodium nitroprusside (in D5W)
I: amiodarone, milrinone
· Peripheral or central line administration.
· Adjust dose in renal impairment.
· Monitor EKG. Discontinue infusion if QRS widens >50% or hypotension develops.
· Active metabolite (NPCA) contributes to toxicity.
· Therapeutic Drug MonitoringTarget range:Procainamide: 15 – 37 mcmol/LPCA + NPCA: < 110 mcmol/L
Toxic range:NPCA: >37 mcmol/L
· Discard solution if dark amber discoloration occurs.
· Change solution at 24 hours.
· Ref: 1, 2, 3
Drug
Concentrations
Infusion Rate
Dose Range
Y-Site Compatibility
Comments
Propofol
[Diprivan]
200 mg/20 mL in 10% soybean emulsion
pH = 6.5 – 8.5
Osmolality = isotonic
May contain metabisulfite or benzyl alcohol
Revised Feb 2020
Standard Concentrations
10 mg/mL* (undiluted)
(10 000 mcg/mL)
To convert to mcg/mL:
· 1 mg/mL = 1000 mcg/mL
Use Alaris Pump to determine infusion rate.
AND
Confirm with the following calculation:
Infusion rate (mL/h) = Dose (mcg/kg/min)
x Weight (kg)
x 60 (min/h)
divided by
Concentration (mcg/ml)
Sedation in Mechanical Ventilation
20 – 60 mcg/kg/min
Start with the lowest effective dose usually
5-10 mcg/kg/min
titrate by
5 – 10 mcg/kg/min q5min
Maintenance of Anesthesia
100 – 250 mcg/kg/min
C:D5W, D5W1/2NS, D5LR, lactated Ringer’s, aminophylline, calcium gluconate, dobutamine, dopamine, esmolol, epinephrine, fentanyl, furosemide, heparin, hydrocortisone, hydromorphone, insulin, isoproterenol, ketamine, labetalol, lidocaine, lorazepam, midazolam, morphine, nitroglycerin, nitroprusside, norepinephrine, potassium chloride, sodium bicarbonate
I: calcium chloride, diazepam
Incompatible with TPN
· Peripheral or central line administration.
· The emulsion vehicle is similar to lipid emulsions such as Intralipid and similar precautions should be observed.
· Do not directly admix with any drug, solution, or blood product.
· For short-term or intermittent use only.
· Propofol-Related Infusion Syndrome (PRIS): metabolic acidosis, lipemia, hypotension, multi-system organ failure, rhabdomyolysis, cardiovascular collapse.
· Change solution and IV administration set at 6 hours.
· Ref: 1, 2, 3, 11
Propofol infusion rate (mL/hour) = Dose (mcg/kg/min) x Weight (kg) X (60 min/hour)
Concentration (10 mg/mL) X 1000 mcg/mg
Drug
Concentrations
Infusion Rate
Dose Range
Y-Site Compatibility
Comments
Salbutamol
[Ventolin]
1 mg/mL
pH: 3.5
Osmolality = isotonic
Created Jun 2020
Standard Concentrations
20 mcg/mL
Add 1 mL of
1 mg/mL to
49 mL NS or D5NS to make 50 mL of
20 mcg/mL
Use Alaris Pump to determine infusion rate.
AND
Confirm with the following calculation:
Infusion rate (mL/h) = Dose (mmol/kg/h)
x Weight (kg)
divided by
Concentration (mmol/mL)
Severe asthma exacerbation
1-5 mcg/kg/min
Start at 1 mcg/kg/min
C: D5W, NS, D5NS, aminophylline, dexamethasone, hydrocortisone
Incompatible with TPN, ketamine
Very little Y site compatibility information.
Contact pharmacy regarding compatibilities.
· Monitor for tachycardia, arrhythmias and hypertension
· Change solution at 24 hours.
· Ref: 1, 3, 6
Drug
Concentrations
Infusion Rate
Dose Range
Y-Site Compatibility
Comments
Sodium Bicarbonate
[NaHCO3]
0.5 mmol/mL (4.2%)
1 mmol/mL (8.4%)
Each mL contains:
8.4% HCO3-
1 mmol HCO3-
1 mEq HCO3-
6% Na+
1 mmol Na+
1 mEq Na+
pH = 7.4 – 8.5
Osmolality =
815 (4.2%)
1815 (8.4%)
Revised Dec 2013
Reviewed May 2020
Standard Concentrations
Peripheral line:
0.5 mmol/mL (4.2%, undiluted)
Central line:
1 mmol/mL (8.4%, undiluted)
Use Alaris Pump to determine infusion rate.
AND
Confirm with the following calculation:
Infusion rate (mL/h) = Dose (mmol/kg/h)
x Weight (kg)
divided by
Concentration (mmol/mL)
Metabolic Acidosis, Continuous Infusion
0.5 – 2 mmol/kg/h
Metabolic Acidosis, Intermittent Infusion
HCO3 (mmol) =
0.3 x weight (kg)
x base deficit (mmol/L)
Administer ½ the calculated dose over 30 – 60 min
C: D5W, D10W, D5NS, NS,
I: alprostadil, amiodarone, amrinone, calcium chloride, calcium gluconate, dopamine, dobutamine, epinephrine, isoproterenol, magnesium, midazolam, norepinephrine, thiopental, vancomycin
Incompatible with TPN
Contact pharmacy regarding compatibilities.
· Central line administration only for 8.4% concentration.
· Rapid infusions in neonates and children may cause hypernatremia, decreased CSF pressure, and intracranial hemorrhage.
· Extravasation may cause local tissue necrosis.
· Change solution at 96 hours.
· Ref: 1, 3
Drug
Concentrations
Infusion Rate
Dose Range
Y-Site Compatibility
Comments
Sufentanil
[Sufenta]
50 mcg/mL in 1 mL and 5 mL vials
pH = 3.5 – 6
Revised April 2008
Reviewed May 2020
Standard Concentrations
Patients < 6 kg:
5 mcg/mL
Add 2.5 mL of
50 mcg/mL to
22.5 mL of D5W to make 25 mL of
5 mcg/mL
Patients 6- 30 kg:
10 mcg/mL
Add 10 mL of
50 mcg/mL to
40 mL of D5W to make 50 mL of
10 mcg/mL
Patients > 30 kg:
20 mcg/mL
Add 20 mL of
50 mcg/mL to
30 mL of D5W to make 50 mL of
20 mcg/mL
Use Alaris Pump to determine infusion rate.
AND
Confirm with the following calculation:
Infusion rate (mL/h) = Dose (mcg/kg/h)
x Weight (kg)
divided by
Concentration (mcg/mL)
Analgesia
0.2 – 1 mcg/kg/h
Intermittent Bolus
0.2 – 0.4 mcg/kg
Anesthesia
Neonates
1 – 2 mcg/kg/h
Infants
1 – 1.5 mcg/kg/h
Children & Adolescents
<1 mcg/kg/h
C: D5W, NS, midazolam, propofol
I: lorazepam, phenobarbital, phenytoin, thiopental
· Peripheral or central line administration.
· Infuse via non PVC tubing (PVC tubing can reduce infusion concentration by 15% in 24 hours)
· Most potent opioid analgesic.
· Bolus administration may cause significant apnea, bradycardia, muscle rigidity, chest wall rigidity. Pretreatment with atropine and a non-depolarizing muscular blocking agent may minimize these effects.
· Antidote: Naloxone 0.01 mg/kg IV
· Change solution at 24 hours.
· Ref: 1, 3, 9
Drug
Concentrations
Infusion Rate
Dose Range
Y-Site Compatibility
Comments
Vasopressin
[Pressyn]
20 units/mL in 0.5 or
5 mL ampoule
1 unit =
1000 milliunits*
*Note: for Alaris pump programming use milliunits
pH = 2.5 – 4.5
Revised Dec 2013
Reviewed May 2020
Standard Concentrations
0.005 units/mL
(5 milliunits/mL)
Add 0.25 mL of 20 units/mL to 1L bag of D5W, NS, or D5NS to make 1000 mL (1L) of 0.005 units/mL
(*note concentration will not be exact and should only be used for DI management)
0.4 units/mL
Add 1 mL of
20 units/mL to
49 mL D5W or NS to make 50 mL of 0.4 units/mL
1 unit/mL
Add 2.5 mL of
20 units/mL to
47.5 mL D5W or NS to make 50 mL of 1 units/mL
Use Alaris Pump to determine infusion rate.
AND
Confirm with the following calculation:
Infusion rate (mL/h) = Dose (milliunits/kg/min)
x Weight (kg)
x 60 (min/h)
divided by
(Concentration (units/mL) X1000 miliunits/unit)
Central Diabetes Insipidus (DI)
0.02 – 0.05 milliunits/kg/min = 0.00002 – 0.00005 units/kg/min
(titrate to desired urine output)
Maximum Dose
0.2 milliunits/kg/min = 0.0002 units/kg/min
Vasodilatory Shock
0.3 – 2 milliunits/kg/min = 0.0003 – 0.002 units/kg/min
C (in D5W): amiodarone, dobutamine, dopamine, heparin, lidocaine, milrinone, nitroglycerin, norepinephrine, phenylephrine, procainamide
C (in NS): amiodarone, epinephrine, norepinephrine
· Central line administration preferred.
· Only the aqueous form may be infused continuously.
· Extravasation may cause tissue necrosis.
· May cause water overload and hyponatremia.
· Change solution at 24 hours.
· Ref: 1, 9
REFERENCES
1. Phelps S, Hagemann TM, Lee KR, Thompson AJ. (Eds) Pediatric Injectable Drugs, 11th Edition . Bethesda. American Society of Health System Pharmacists; 2017.
2. Taketomo CK, Hodding JH, Kraus DM, (Eds). Pediatric Dosage Handbook 25th Edition. Hudson Lexicomp; 2018.
3. Trissel’s ™ 2 Clinical Pharmaceutics Database , Micromedex 2.0 June 2020. https://www.micromedexsolutions.com/micromedex2/4.29.4.1/WebHelp/Tools/IV_Compatibility/IV_Compatibility.htm
4. Yong TE, Mangum B. (Ed). Neofax: IBM Micromedex® June 2020
5. Esau R (Ed).Pediatrics Drug Dosage Guidelines, 7th Edition . Vancouver. BC Children’s Hospital; 2018.
6. BC Children’s Hospital Parenteral Manual. Vancouver. BC Children’s Hospital. June 2020
7. “Our Standard Concentrations Updated 11/05/04”. University of Maryland School of Medicine. 2004. ICUDrips.org
8. Kent D, WIlis G, (Editors). Poison Management Manual. Vancouver. British Columbia Drug and Poison Information Centre. 2017.
9. Shann F. Drug Doses 17th Edition. Parkville. Intensive Care Unit, Royal Children’s Hospital.2017 http://www.drugdoses.com/
10. Flolan Product Monograph 2019 https://ca.gsk.com/media/1220385/flolan.pdf
11. Repchinsky C(ed). Compendium of Pharmaceutical and Specialties 2018 23rd Edition. Ottawa. Canadian Pharmacists Association. 2018
12. Heulitt MJ et al. Double-blind, randomized, controlled trial of papaverine-containing infusions to prevent failure of arterial catheters in pediatric patients. Crit Care Med 1993;21:825-9.
Version History
DATE
DOCUMENT NUMBER and TITLE
ACTION TAKEN
14-July-2020
C-05-07-60741 Pediatric Intensive Care Unit: Continuous Infusion Guidelines for Infants and Children
Approved at: Pharmacy, Therapeutics & Nutrition Committee
DISCLAIMER
This document is intended for use within BC Children’s and BC Women’s Hospitals only. Any other use or reliance is at your sole risk. The content does not constitute and is not in substitution of professional medical advice. Provincial Health Services Authority (PHSA) assumes no liability arising from use or reliance on this document. This document is protected by copyright and may only be reprinted in whole or in part with the prior written approval of PHSA.
C-05-07-60741 Published Date: 28-Jul-2020
Page 2 of 40 Review Date: 14-Jul-2023
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